TY - JOUR
T1 - Impact of the societal response to covid-19 on access to healthcare for non-covid- 19 health issues in slum communities of bangladesh, kenya, nigeria and pakistan
T2 - Results of pre-covid and covid-19 lockdown stakeholder engagements
AU - Ahmed, Syed A.K.Shifat
AU - Ajisola, Motunrayo
AU - Azeem, Kehkashan
AU - Bakibinga, Pauline
AU - Chen, Yen Fu
AU - Choudhury, Nazratun Nayeem
AU - Fayehun, Olufunke
AU - Griffiths, Frances
AU - Harris, Bronwyn
AU - Kibe, Peter
AU - Lilford, Richard J.
AU - Omigbodun, Akinyinka
AU - Rizvi, Narjis
AU - Sartori, Jo
AU - Smith, Simon
AU - Watson, Samuel I.
AU - Wilson, Ria
AU - Yeboah, Godwin
AU - Aujla, Navneet
AU - Azam, Syed Iqbal
AU - Diggle, Peter J.
AU - Gill, Paramjit
AU - Iqbal, Romaina
AU - Kabaria, Caroline
AU - Kisia, Lyagamula
AU - Kyobutungi, Catherine
AU - Madan, Jason J.
AU - Mberu, Blessing
AU - Mohamed, Shukri F.
AU - Nazish, Ahsana
AU - Odubanjo, Oladoyin
AU - Osuh, Mary E.
AU - Owoaje, Eme
AU - Oyebode, Oyinlola
AU - De Albuquerque, Joao Porto
AU - Rahman, Omar
AU - Tabani, Komal
AU - Taiwo, Olalekan John
AU - Tregonning, Grant
AU - Uthman, Olalekan A.
AU - Yusuf, Rita
N1 - Funding Information:
Funding This research was funded by the National Institute for Health Research (NIHR) Global Health Research Unit on Improving Health in Slums using UK aid from the UK Government to support global health research. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the UK Department of Health and Social Care.
Funding Information:
Twitter Godwin Yeboah @GodwinYeboah, Shukri F Mohamed @shukrifmohamed, Joao Porto de Albuquerque @j_p_albuquerque and Grant Tregonning @GrantTregonning Acknowledgements We are grateful to all of the study participants who gave so generously of their insights and time. We are thankful to the two anonymous reviewers for their constructive comments on the manuscript. MA gratefully acknowledges support provided by the Warwick Institute of Advanced Study Global Challenges Research Fund Fellowship No. IAS/32013/19. FG receives funding as South Africa Research Chair in Health Policy and Systems from the National Research Foundation, South Africa. RJL is supported by the NIHR Applied Research Collaboration (ARC) West Midlands, UK.
Funding Information:
COVID-19 crisis intervention fund established to upgrade health facilities.59 Lagos State: granted N10 billion (US$28million) to support containment efforts Contingency funds of N984 million (US$2.7million) released by Nigeria’s Center for Disease Control, and additional N6.5 billion (US$18million) made available for training of medical personnel, test kits, isolation centres. 16/04: N42.6 billion raised, including US$50million grant from the European Union.56
Publisher Copyright:
© 2021 American Medical Association. All rights reserved.
PY - 2020/8/5
Y1 - 2020/8/5
N2 - Introduction With COVID-19, there is urgency for policymakers to understand and respond to the health needs of slum communities. Lockdowns for pandemic control have health, social and economic consequences. We consider access to healthcare before and during COVID-19 with those working and living in slum communities. Methods In seven slums in Bangladesh, Kenya, Nigeria and Pakistan, we explored stakeholder perspectives and experiences of healthcare access for non-COVID- 19 conditions in two periods: Pre-COVID- 19 and during COVID-19 lockdowns. Results Between March 2018 and May 2020, we engaged with 860 community leaders, residents, health workers and local authority representatives. Perceived common illnesses in all sites included respiratory, gastric, waterborne and mosquitoborne illnesses and hypertension. Pre-COVID, stakeholders described various preventive, diagnostic and treatment services, including well-used antenatal and immunisation programmes and some screening for hypertension, tuberculosis, HIV and vectorborne disease. In all sites, pharmacists and patent medicine vendors were key providers of treatment and advice for minor illnesses. Mental health services and those addressing gender-based violence were perceived to be limited or unavailable. With COVID-19, a reduction in access to healthcare services was reported in all sites, including preventive services. Cost of healthcare increased while household income reduced. Residents had difficulty reaching healthcare facilities. Fear of being diagnosed with COVID-19 discouraged healthcare seeking. Alleviators included provision of healthcare by phone, pharmacists/drug vendors extending credit and residents receiving philanthropic or government support; these were inconsistent and inadequate. Conclusion Slum residents' ability to seek healthcare for non-COVID- 19 conditions has been reduced during lockdowns. To encourage healthcare seeking, clear communication is needed about what is available and whether infection control is in place. Policymakers need to ensure that costs do not escalate and unfairly disadvantage slum communities. Remote consulting to reduce face-to- face contact and provision of mental health and gender-based violence services should be considered.
AB - Introduction With COVID-19, there is urgency for policymakers to understand and respond to the health needs of slum communities. Lockdowns for pandemic control have health, social and economic consequences. We consider access to healthcare before and during COVID-19 with those working and living in slum communities. Methods In seven slums in Bangladesh, Kenya, Nigeria and Pakistan, we explored stakeholder perspectives and experiences of healthcare access for non-COVID- 19 conditions in two periods: Pre-COVID- 19 and during COVID-19 lockdowns. Results Between March 2018 and May 2020, we engaged with 860 community leaders, residents, health workers and local authority representatives. Perceived common illnesses in all sites included respiratory, gastric, waterborne and mosquitoborne illnesses and hypertension. Pre-COVID, stakeholders described various preventive, diagnostic and treatment services, including well-used antenatal and immunisation programmes and some screening for hypertension, tuberculosis, HIV and vectorborne disease. In all sites, pharmacists and patent medicine vendors were key providers of treatment and advice for minor illnesses. Mental health services and those addressing gender-based violence were perceived to be limited or unavailable. With COVID-19, a reduction in access to healthcare services was reported in all sites, including preventive services. Cost of healthcare increased while household income reduced. Residents had difficulty reaching healthcare facilities. Fear of being diagnosed with COVID-19 discouraged healthcare seeking. Alleviators included provision of healthcare by phone, pharmacists/drug vendors extending credit and residents receiving philanthropic or government support; these were inconsistent and inadequate. Conclusion Slum residents' ability to seek healthcare for non-COVID- 19 conditions has been reduced during lockdowns. To encourage healthcare seeking, clear communication is needed about what is available and whether infection control is in place. Policymakers need to ensure that costs do not escalate and unfairly disadvantage slum communities. Remote consulting to reduce face-to- face contact and provision of mental health and gender-based violence services should be considered.
UR - http://www.scopus.com/inward/record.url?scp=85096576468&partnerID=8YFLogxK
U2 - 10.1136/bmjgh-2020-003042
DO - 10.1136/bmjgh-2020-003042
M3 - Article
AN - SCOPUS:85096576468
SN - 2059-7908
VL - 5
JO - BMJ Global Health
JF - BMJ Global Health
IS - 8
M1 - e003042
ER -